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Type 5 Diabetes
Type 5 diabetes recognised as a distinct form of disease: why is this significant?
Context: Type 5 diabetes was officially classified as a distinct form of diabetes by the International Diabetes Federation (IDF) at the 75th Diabetes World Congress in Bangkok (April 7, 2025).
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- IDF President Peter Schwarz called it a “historic shift,” noting it affects 25 million people globally and has long been overlooked or misdiagnosed.
- It currently affects an estimated 25 million people globally, predominantly in the Global South, including India, Sri Lanka, Bangladesh, Uganda, Ethiopia, Rwanda, and Korea.
What is Type 5 Diabetes?
- Type 5 diabetes primarily affects lean and malnourished teenagers and young adults in low- and middle-income countries.
- It is caused by malnutrition-induced reduction in insulin production.
- This form of diabetes involves abnormal functioning of pancreatic beta cells, leading to severely reduced insulin secretion.
- Unlike Type 2 diabetes, which is characterised by insulin resistance, Type 5 is due to insufficient insulin production.
Recognition and Historical Background
- It was first reported in Jamaica in 1955 as ‘J-type diabetes’.
- Classified by the World Health Organisation (WHO) in 1985 as “malnutrition-related diabetes mellitus”.
- The WHO dropped the classification in 1999 due to lack of conclusive evidence linking malnutrition to diabetes.
- A 2023 meta-analysis in The Lancet Diabetes & Endocrinology established a clear link between malnutrition and pancreatic dysfunction.
- Reclassified as “Type 5 diabetes” by the IDF in January 2025, with formal endorsement in April 2025.
Cause: Malnutrition from the Womb
- Referred to as SIDD (Severe Insulin-Deficient Diabetes).
- Inadequate nutrition in utero can impair fetal development, including the pancreas, increasing the risk of diabetes in later life. A 2022 WHO report found that 200 million children under 5 in low-income countries suffer from stunting, increasing diabetes risk.
- Dr C S Yajnik (Director, Diabetes Unit, KEM Hospital Pune) explains:
- Undernutrition in the womb followed by continued undernutrition after birth leads to Type 5 diabetes.
- In contrast, undernutrition followed by excessive weight gain later in life is linked to Type 2 diabetes.
- Historical factors like colonisation, famine, and hard labour contributed to widespread undernutrition in several developing countries.
Key Characteristics of Type 5 Diabetes
- They exhibit a significantly lower Body Mass Index (BMI) — typically less than 18.5 kg/m².
- Insulin secretion: Reduced by up to 70% compared to healthy individuals.
- Fat percentage: Only 10-12%, compared to 20-25% in healthy adults.
- Dietary deficiencies: Low intake of proteins, fibre, zinc, and vitamin A.
- Symptoms: Fatigue, significant weight loss, frequent infections.
- No autoimmune or genetic cause — makes it distinct from Type 1 or Type 2.
Next Steps for Diagnosis and Treatment
- A Type 5 Diabetes Working Group is actively working to study diverse populations over the next two years, especially in low-income, low-resource settings.
- Focuses on reversing malnutrition: A high-protein diet (legumes, fish) is essential for weight gain and glycemic control.
- Depending on BMI and activity levels, adequate carbohydrates and fats are also needed for healthy weight gain.
- Metformin or low-dose insulin is prescribed based on glucose levels—not high-dose insulin, which risks hypoglycemia.
Why Recognition Matters?
- For decades, this condition was overlooked, and often misdiagnosed as Type 1 or Type 2 diabetes.
- Official recognition brings attention to the distinct nature of malnutrition-linked diabetes, especially affecting marginalised populations in the Global South.
- It opens doors for dedicated research, policy attention, and targeted healthcare interventions.
